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Individual
MS. ILYSSA BAIN
Active
Individual
MS. ILYSSA BAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-AC
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
259452
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120424
—
AZ
Enumeration date
12/04/2021
Last updated
02/22/2024
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